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Physical Activity

Aerobics stepperOnce a company has conducted assessment and planning of physical activity programs, and developed the specific tasks of implementation for these programs, it is time to develop the evaluation plan. The evaluation plan should be in place before any program implementation has begun.

Metrics for worker productivity, health care costs, heath outcomes, and organizational change allow measurement of the beginning (baseline), middle (process), and results (outcome) of workplace health programs.  It is not necessary to use all these metrics for evaluating programs.  Some information may be difficult or costly to collect, or may not fit the operational structure of a company.  These lists are only suggested approaches that may be useful as in designing an evaluation plan.

These measures are designed for employee group assessment. They are not intended for examining an individual’s progress over time, which would raise concerns of employee confidentiality. For employer purposes, individual-level measures should be collected anonymously and only reported (typically by a third party administrator) in the aggregate, because the company’s major concerns are overall changes in productivity, health care costs, and employee satisfaction.

In general, data from the previous 12 months will provide sufficient baseline information and can be used in establishing the program goals and objectives in the planning phase, and in assessing progress toward goals in the evaluation phase.  Ongoing measurements every 6 to 12 months after programs begin are usually appropriate measurement intervals, but measurement timing should be adapted to the expectations of the specific program.

Regular physical activity is one of the most effective disease prevention behaviors.  Physical activity programs:

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Worker productivity measures for physical activity1-3

Healthier employees are less likely to call in sick.  Companies can sometimes assess sick day use as the most direct measure to determine whether health programs are increasing worker productivity.

Baseline
  • Determine the average number of sick days per employee over the previous 12 months for health conditions related to physical inactivity such as hypertension
    • This measure may be less useful if there has been a large increase or decrease in numbers of employees over the past 12 months
  • Determine the costs of worker absenteeism including costs of replacement workers, costs in training replacement workers, and loss and delay in productivity
  • Determine time employees spend during working hours participating in physical activity-related worksite programs
Process
  • Re-assess the average number of sick days per employee for physical inactivity-related conditions at the first follow-up evaluation
  • Periodic repeats of other baseline measures
Outcome
  • Assess changes in the average number of sick days per employee for physical inactivity-related conditions in repeated follow-up evaluations
  • Assess changes in time employees spend during working hours participating in physical activity-related worksite programs
  • Assess changes in costs from baseline

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Health care cost measures for physical activity1-3

In contrast with the worker productivity costs described above, health care costs are measures of the direct medical expenses of providing employee health care and preventive health programs.

Baseline
  • Determine current health care use and costs for conditions where individuals have a higher risk associated with physical inactivity such as obesity, high blood pressure, high cholesterol, heart disease and stroke, and type 2 diabetes 
    • It is difficult to attribute the effects of enhanced physical activity directly to the costs of health care, but tracking this information over time gives the program evaluator an indication of the physical activity program’s impact
  • Determine the health care use and costs of program participants before education and other programs are initiated and after operation of these programs
Process
  • Periodic repeats of baseline measures
Outcome
  • Assess changes in health care use and costs from baseline
  • Compare health care use and costs of program participants before education and other programs are initiated and after operation of these programs

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Health outcomes measures for physical activity1-4

The effectiveness of physical activity programs depends on the intensity of program efforts and the use of multiple interventions.  A rule of thumb is that the more programs implemented together as a package or campaign, the more successful the interventions will be.

Baseline
Process
  • Periodic repeats of baseline measures
Outcome
  • Assess changes in employee levels of physical activity such as:
    • Changes in overall level of leisure time physical activity and in the percentage of employee who achieved recommended levels of physical activity before and after the physical activity campaign or program
    • Changes in the frequency or duration (e.g., increase in the total number of minutes or steps walked through a workplace walking program) of employee physical activity
    • Changes in aerobic fitness through biometric screening
  • Assess changes in the percentage of employees with health conditions, where individuals have a higher risk associated with physical inactivity, such as obesity, high blood pressure, high cholesterol, heart disease and stroke, and type 2 diabetes
    • Compare health status changes of program participants before education and other programs are initiated and after operation of these programs
    • It is difficult to attribute the exact effects of enhanced physical activity on the development of health conditions such as high cholesterol which has other risk factors such as diet or genetics, or can be impacted by other interventions such as medication, but tracking this information over time gives the program evaluator an indication of the physical activity program’s impact
  • Assess changes in employee knowledge, attitudes, and beliefs about physical activity
    • Evaluate changes in employees’ knowledge of the health benefits of physical activity
    • Assess changes in the number of employees who are not physically active, but are thinking about engaging in physical activity or state that they want to change their physical activity habits
    • Assess changes in employee awareness of existing workplace physical activity programs, policies, and benefits

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Organizational change measures for physical activity1-3

Man looking at book

Physical activity, along with other health habits, require ongoing support from employers.  New programs can be added over time and evaluated periodically for their effectiveness in establishing, maintaining, and increasing employee physical activity.  For best results, recognition of the benefits of physical activity should become an inherent part of organizational change and corporate culture.

Measuring organization change is an assessment of company-initiated programs and policies that affect most employees regardless of their health status (e.g., establishing walking trails on the company campus).  These efforts need to be integrated for greatest effectiveness and will require time for full implementation.  Regular measures of employee attitudes and program success are key in determining whether new programs are effective or require further adaptation to prevent continuing investment in ineffective efforts.

Baseline
  • Determine workplace barriers to employee’s engagement in physical activity
  • Assess current workplace physical activity programs
    • List current physical activity options for employees through worksite and identify number of employees (i.e., participation) using each option. Examples:
      • Number of physical activity programs (e.g., education seminars, group physical activity classes), availability and use of physical activity facilities
      • Availability of educational materials on physical activity
      • Number of physical activity-related policies
      • Number of environmental strategies such as stairway signs, walking trails, and exercise rooms
      • Number of partnerships with community resources for physical activity such as YMCAs or health clubs
    • Determine costs of current company physical activity programs such as:
      • Gym memberships
      • Capital investment in buildings, facilities, or campus
      • Staffing, equipment, and space
      • Maintenance of on-site fitness equipment or facilities
      • Incentives tied to physical activity programs
    • Conduct survey of employee satisfaction with current workplace supported physical activity options
Process
  • Reassess barriers to employee physical activity
  • Document steps taken and progress toward implementing each intervention selected
    • List numeric goals in each form of intervention within a designated time period (e.g., 12 months from startup):
      • Employee reach (e.g., number of educational pamphlets distributed)
      • Employee participation (e.g., number of desired participants in physical activity classes)
    • Describe timeline for implementation of each planned intervention (e.g., length of time and timing of tasks to develop, initiate, and conduct a mass campaign)
    • Create a baseline budget for new interventions including classes, instructors, classroom space, exercise equipment, gym fees, etc
    • Identify opportunities for new partnerships with community groups who provide physical activity programs (e.g., YMCA, local health department, local health club, etc.)
  • Reassess employee satisfaction regarding workplace supported physical activity programs
Outcome
  • Measure reductions in the number and type of employee barriers in engaging in physical activity at the workplace
  • Assess changes in workplace physical activity programs
    • Measure changes in the number of physical activity options for employees through the worksite and changes in employee participation using each option before and after the physical activity program or campaign. Examples:
      • Number of new programs developed and offered to employees and participation in these programs
      • Number of new educational materials developed and made available to employees
      • Number of physical activity-related polices developed and implemented compared to baseline
      • Number and type of new environmental support changes made (e.g., number of multi-purpose rooms allocated to physical activity; walking trail or fitness facility built; changes in hours of operation in existing fitness facility)
        • Using the walkability audit tool, the number of walkability enhancements can be documented
      • Number of new partnerships with community groups created to enhance access and opportunity for employees to be physically active
    • Assess changes in program costs from baseline
      • New capital investments made (e.g., on-site fitness facilities)
      • Increases in staffing or equipment needs due to new program offerings
      • New incentives or changes in existing incentives based on employee participation
    • Assess changes in survey responses for employee satisfaction following implementation of a workplace supported physical activity program and compare with baseline

Depending on goal success, evaluate the need to adjust workplace programs.


Tools and Resources

Physical Activity Baseline Measures

The assessment tools described in the assessment module include specific questions related to physical activity.

  Health-related Programs

  • Q11; Q12; Q13; Q20c; Q21d,e,f,g; Q24a,b,c,d,e,h,l; Q25; Q26; Q27; Optional Questions A, B, C, I, J, M, N, OO

  Health-related Policies

  • Q28c

  Health Benefits

  • Q32; Q37; Optional Question T, AA

  Environmental Support

  • Q24g; Q39; Q40; Q41; Q43; Q46; Q47; Optional Question CC, GG, HH, JJ
Additional Tools
  • CDC Health Scorecard [PDF – 3.5MB] developed by the Centers for Disease Control and Prevention (CDC), the Health Scorecard is a tool designed to help employers assess the extent to which they have implemented evidence-based health promotion interventions or strategies in their worksites to prevent heart disease, stroke, and related conditions such as hypertension, diabetes, and obesity.
  • Physical Activity Evaluation Handbook [PDF - 576KB] developed by the Centers for Disease Control and Prevention (CDC)
  • Physical Inactivity Cost Calculator developed by East Carolina University with support from CDC and other partners
  • The CDC physical activity website describes approaches to self-monitoring of physical activity intensity
  • The CDC Healthier Worksite Initiative has developed a tool to help assess and evaluate workplace walkability
  • The CDC Healthier Worksite Initiative has developed tips and strategies for tracking stairwell use
  • Health Risk Appraisals at the Worksite: Basics for HRA Decision Making [PDF - 2.3MB] is a guide developed by the National Business Coalition on Health in collaboration with the Centers for Disease Control and Prevention (CDC) in the selection and use of health risk appraisals in the workplace available for employers
  • The CDC Healthy Communities Program developed the Community Health Assessment and Group Evaluation (CHANGE) assessment tool to provide communities with a picture of the policy, systems, and environmental change strategies currently in place throughout the community, where gaps exists and facilitate action planning for making improvements. The CHANGE tool address five community sectors including worksites and health indicators related to physical activity, nutrition, tobacco use, chronic disease management, and leadership

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